Children and risk of Norovirus

[ldubs]

4 hours ago, cruisemom42 said:

 

 

If you read the quoted post above yours carefully, it also says that cruise lines are REQUIRED to report any outbreak of more than 2% of passengers, while land-based establishments do not have the same requirements. I'm guessing you don't increase your odds by cruising. You're just more likely to be aware of it/to be reported.

 

 

Huh, interesting observation.   Of course that means you could have a 100 passengers & crew with noro and no report.   I'm happy to have never experienced a noro outbreak, at least that I know of.  When a severe one happens, what percentage of the passengers normally are involved?  I realize there will be a range, but would a big incident involve 5% or passengers, or more, or less?  A ballpark is fine.  Just curious.  

[ldubs]

On 7/31/2019 at 11:25 AM, clo said:

I think people tend to freak over the word "noro" but not over "stomach bug."

 

I think the "freaking out" with regards to cruises are the lock-downs we all read about.  I've also talked to people who got the stomach flu on a cruise and just toughed it out because they were afraid they would be quarantined.  

 

Some time ago I posted my curiosity about whether some of these incidents were food poisoning instead of noro.  Someone responded that the ship clinic would do lab work to ID noro.  I think that makes sense because they would not go to all of the trouble they do following an outbreak if it wasn't noro.  

[clo]

14 minutes ago, ldubs said:

 

I think the "freaking out" with regards to cruises are the lock-downs we all read about.  I've also talked to people who got the stomach flu on a cruise and just toughed it out because they were afraid they would be quarantined.  

 

Some time ago I posted my curiosity about whether some of these incidents were food poisoning instead of noro.  Someone responded that the ship clinic would do lab work to ID noro.  I think that makes sense because they would not go to all of the trouble they do following an outbreak if it wasn't noro.  

As I understand it, it's generally just diagnosed by symptoms.  It doesn't seem like a ship's lab could handle that.

https://www.cdc.gov/norovirus/lab/diagnosis.html

 

[ldubs]

10 minutes ago, clo said:

As I understand it, it's generally just diagnosed by symptoms.  It doesn't seem like a ship's lab could handle that.

https://www.cdc.gov/norovirus/lab/diagnosis.html

 

 

As I understand, a very few (like 4 or 5) reported gastrointestinal issues will start the remediation process and that there are tests on board to determine it is noro vs say salmonella.  I do hope this is the case, because the symptoms for food poisoning seem to be similar and the response needs to be directed properly.   

[clo]

2 minutes ago, ldubs said:

 

As I understand, a very few (like 4 or 5) reported gastrointestinal issues will start the remediation process and that there are tests on board to determine it is noro vs say salmonella.  I do hope this is the case, because the symptoms for food poisoning seem to be similar and the response needs to be directed properly.   

While Noro is a virus and Salmonella is a bacteria generally they're both just treated symptomatically.

[ldubs]

3 minutes ago, clo said:

While Noro is a virus and Salmonella is a bacteria generally they're both just treated symptomatically.

 

Clo, I agree an individual's treatment is directed at symptoms.  What I'm talking about is how the ship ID's the condition in order to respond properly to limit spread/impact, not to mention meeting mandated reporting requirements.  I'm thinking it is more likely tests are done in order to comply with whatever authority has jurisdiction.   I'll admit I'm not an expert and jumping to a conclusion, but I think that is how it works.  

[clo]

Just now, ldubs said:

 

Clo, I agree an individual's treatment is directed at symptoms.  What I'm talking about is how the ship ID's the condition in order to respond properly to limit spread/impact, not to mention meeting mandated reporting requirements.  I'm thinking it is more likely tests are done in order to comply with whatever authority has jurisdiction.   I'll admit I'm not an expert and jumping to a conclusion, but I think that is how it works.  

The link I gave is very technical but everything I read/skimmed indicated that testing is done at, say, county health departments and the like and that the patient is well before the results come back.  If anyone's on a ship right now maybe ask them.

[ldubs]

5 minutes ago, clo said:

The link I gave is very technical but everything I read/skimmed indicated that testing is done at, say, county health departments and the like and that the patient is well before the results come back.  If anyone's on a ship right now maybe ask them.

 

I don't think the link pertains to cruise ship incidents or reporting requirements.   I suppose this is going to go on forever if we don't agree to disagree or until someone more knowledgable chips in.   

Edited August 4, 2019 by ldubs

[clo]

1 minute ago, ldubs said:

 

I don't think the link pertains to cruise ship incidents or reporting requirements.   I suppose this is going to go on forever if we don't agree to disagree or until someone more knowledgable chips in.   

I loathe "agree to disagree" phrase 🙂

 

BTW, I have quite a bit of medical background including working in a lab at CDC and selling clinical laboratory services.  I'm not referring to any requirement for reporting.  You can likely research THAT one.

[clo]

1 minute ago, ldubs said:

 

I don't think the link pertains to cruise ship incidents or reporting requirements.   I suppose this is going to go on forever if we don't agree to disagree or until someone more knowledgable chips in.   

I loathe "agree to disagree" phrase 🙂

 

BTW, I have quite a bit of medical background including working in a lab at CDC and selling clinical laboratory services.  I'm not referring to any requirement for reporting.  You can likely research THAT one.

[ldubs]

5 minutes ago, clo said:

I loathe "agree to disagree" phrase 🙂

 

BTW, I have quite a bit of medical background including working in a lab at CDC and selling clinical laboratory services.  I'm not referring to any requirement for reporting.  You can likely research THAT one.

 

OK, then let's agree we are talking about two different things.  

 

Anyway, with your lab background, would running a stool sample by a cruise ship clinic be difficult? 

[clo]

21 minutes ago, ldubs said:

 

OK, then let's agree we are talking about two different things.  

 

Anyway, with your lab background, would running a stool sample by a cruise ship clinic be difficult? 

So this link says that a virus can be cultured from a stool specimen - a probably lengthy process requiring equipment and reagents and skilled lab personnel.  It also says an electron microscope - again requiring expensive equipment and trained staff.  Not a doctor or nurse.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1145558/

And here's something from CDC about VSP _ Vessel Sanitation Program.

https://www.cdc.gov/nceh/vsp/

 

I'm going to make a guess here and say that an outbreak of nausea, vomiting and diarrhea is inaccurately labeled as "norovirus."  Inaccurate but it gets the job done.  It notifies people that a virulent outbreak has occurred.

Edited August 4, 2019 by clo
typos

[cruisemom42]

20 minutes ago, ldubs said:

 

I don't think the link pertains to cruise ship incidents or reporting requirements.   I suppose this is going to go on forever if we don't agree to disagree or until someone more knowledgable chips in.   

 

I'm not going to claim to be more knowledgeable, but I did stay in a Holiday Inn Express last night, and...

 

Just kidding, but in the absence of someone like BruceMuzz answering, I doubt we'll get a truly knowledgeable report. However, I found an article published on the NIH website that was investigating norovirus outbreaks on cruise ships -- looking for patterns in terms of where and when they occur. The article contains the following statement:

 

...it should be noted that more than half of the cases examined for norovirus tested negative by immunochromatographic test for norovirus genogroups I and II. These results were not confirmed by a second molecular method, which might have increased the proportion of positive laboratory tests. Notwithstanding this, the policy of the company to perform microbiological analysis of clinical specimens of patients for norovirus and bacteria aids early recognition of the aetiology of outbreaks and can be of value for informing decision making on adequate control measures. 

 

My interpretation of this is that cruise lines DO carry out testing for noro. 

[clo]

10 minutes ago, cruisemom42 said:

 

I'm not going to claim to be more knowledgeable, but I did stay in a Holiday Inn Express last night, and...

 

Just kidding, but in the absence of someone like BruceMuzz answering, I doubt we'll get a truly knowledgeable report. However, I found an article published on the NIH website that was investigating norovirus outbreaks on cruise ships -- looking for patterns in terms of where and when they occur. The article contains the following statement:

 

...it should be noted that more than half of the cases examined for norovirus tested negative by immunochromatographic test for norovirus genogroups I and II. These results were not confirmed by a second molecular method, which might have increased the proportion of positive laboratory tests. Notwithstanding this, the policy of the company to perform microbiological analysis of clinical specimens of patients for norovirus and bacteria aids early recognition of the aetiology of outbreaks and can be of value for informing decision making on adequate control measures. 

 

My interpretation of this is that cruise lines DO carry out testing for noro. 

And my interpretation is that they pay a clinical laboratory to do that testing.  The results/data will help them make future decisions about "adequate control measures."

 

The vast majority of sick people are well in just a few days, treating them symptomatically.  And what I've read indicates that there's no anti-viral treatment and I'm guessing none will be developed.  It costs a whole lot of money to create a new drug and this virus causes few long term problems and is usually gone in a very few days.

 

[cruisemom42]

Okay, here we go -- getting closer. For ships that participate in the Vessel Sanitation Program (which, I believe is required of any with US ports of call), I just read through the specific guidelines -- riveting reading.

 

Greatly simplified:

 

First, they define what is considered a reportable case (i.e., 3 or more episodes of diarrhea or vomiting + one additional symptom).

 

Then they make it clear that ships must make a report of cases within a certain window of time (36-24 hours) before reaching a US port -- even if that number is zero.

 

It appears that when the number of reported outbreaks of acute gastrointestinal illness is below the CDC threshold of 2%, no testing is required. The ships must keep a log that identifies the passenger or crew member and whether various symptoms of illness are or are not present along with certain other data. HOWEVER, when the threshold exceeds 2%, samples are taken and shipped off (presumably to whatever laboratory they are directed to use by CDC) for bacterial and/or viral analysis.

[ldubs]

39 minutes ago, cruisemom42 said:

 

I'm not going to claim to be more knowledgeable, but I did stay in a Holiday Inn Express last night, and...

 

Just kidding, but in the absence of someone like BruceMuzz answering, I doubt we'll get a truly knowledgeable report. However, I found an article published on the NIH website that was investigating norovirus outbreaks on cruise ships -- looking for patterns in terms of where and when they occur. The article contains the following statement:

 

...it should be noted that more than half of the cases examined for norovirus tested negative by immunochromatographic test for norovirus genogroups I and II. These results were not confirmed by a second molecular method, which might have increased the proportion of positive laboratory tests. Notwithstanding this, the policy of the company to perform microbiological analysis of clinical specimens of patients for norovirus and bacteria aids early recognition of the aetiology of outbreaks and can be of value for informing decision making on adequate control measures. 

 

My interpretation of this is that cruise lines DO carry out testing for noro. 

 

I had drawn a similar conclusion from look-ups I did.   Anyway, I find it hard to think a medical professional make a decision based on a best guess when being wrong could have severe consequences.   But, I've been wrong before.  

[clo]

1 minute ago, cruisemom42 said:

Greatly simplified:

 

Terrific explanation.  I was too lazy to be honest.  That testing might even be done by CDC.  Back in the dark ages when I worked there, we got things from literally all over the US and even the world at times.  And those test results will come after the fact, probably WAY after the fact, and will provide information for future travel(s).  Thanks.  Good job.

[ldubs]

1 minute ago, cruisemom42 said:

Okay, here we go -- getting closer. For ships that participate in the Vessel Sanitation Program (which, I believe is required of any with US ports of call), I just read through the specific guidelines -- riveting reading.

 

Greatly simplified:

 

First, they define what is considered a reportable case (i.e., 3 or more episodes of diarrhea or vomiting + one additional symptom).

 

Then they make it clear that ships must make a report of cases within a certain window of time (36-24 hours) before reaching a US port -- even if that number is zero.

 

It appears that when the number of reported outbreaks of acute gastrointestinal illness is below the CDC threshold of 2%, no testing is required. The ships must keep a log that identifies the passenger or crew member and whether various symptoms of illness are or are not present along with certain other data. HOWEVER, when the threshold exceeds 2%, samples are taken and shipped off (presumably to whatever laboratory they are directed to use by CDC) for bacterial and/or viral analysis.

 

Thanks.  That helps clarify.  I wonder if in addition to the noro loss control (cleaning, etc) that they also inspect food handling just in case it is food poisoning.   

[clo]

3 minutes ago, ldubs said:

Anyway, I find it hard to think a medical professional make a decision based on a best guess when being wrong could have severe consequences.  

But the treatments are so benign.  Keep them hydrated, bland diet.  For both bacterial and viral infections that are generally self-limiting.

[ldubs]

Just now, clo said:

But the treatments are so benign.  Keep them hydrated, bland diet.  For both bacterial and viral infections that are generally self-limiting.

 

We are still talking about two different things.  You are discussing treatment.  I am talking about how to manage the risk.  If a noro outbreak then address ways it will spread.   If food poisoning, instead of cloroxing handrails, it might be better to focus on whatever food handling issue caused the problem.   

[clo]

5 minutes ago, ldubs said:

 

Thanks.  That helps clarify.  I wonder if in addition to the noro loss control (cleaning, etc) that they also inspect food handling just in case it is food poisoning.   

"Food poisoning" is a HUGE category.

https://www.mayoclinic.org/diseases-conditions/food-poisoning/symptoms-causes/syc-20356230

 

BTW, I only share VERY reputable medical citations.  The internet is rife with anecdotal and just plain false info.

[clo]

2 minutes ago, ldubs said:

 

We are still talking about two different things.  You are discussing treatment.  I am talking about how to manage the risk.  If a noro outbreak then address ways it will spread.   If food poisoning, instead of cloroxing handrails, it might be better to focus on whatever food handling issue caused the problem.   

But all they can do is "best guess."  Until lab results come back they can't further pin it down.  Did you see the list of foods that can cause "food poisoning"?  Can you imagine what it would take to check even a few of those?

[clo]

10 minutes ago, ldubs said:

 

We are still talking about two different things.  You are discussing treatment.  I am talking about how to manage the risk.  If a noro outbreak then address ways it will spread.   If food poisoning, instead of cloroxing handrails, it might be better to focus on whatever food handling issue caused the problem.   

https://health.clevelandclinic.org/five-simple-tips-to-prevent-norovirus-this-winter/

 

Cleveland Clinic is highly reputable also.  And they all list these five things.  

[ldubs]

3 hours ago, clo said:

But all they can do is "best guess."  Until lab results come back they can't further pin it down.  Did you see the list of foods that can cause "food poisoning"?  Can you imagine what it would take to check even a few of those?

 

Sure sounds that way to me.   Re food poisoning, without proper processing/handling any food can become unsafe.  You know like raw poultry juice dripping onto veggies stored on a lower shelf.  Yummy.   

[clo]

1 minute ago, ldubs said:

 

Sure sounds that way to me.   Re food poisoning, without proper processing/handling any food can become unsafe.  You know like raw poultry juice dripping onto veggies stored on a lower shelf.  Yummy.   

And the problem with lettuce(s) that began on their farm.